Opinion statement
-
Biliary dyskinesia is a motility disorder that affects the gallbladder and sphincter of Oddi.
-
The motility disorder of the gallbladder is called gallbladder dyskinesia. Patients with this condition present with biliary-type pain, and investigations show no evidence of gallstones in the gallbladder. The diagnosis is made by performing a gallbladder ejection fraction, which is a radionuclide investigation. An abnormal gallbladder ejection fraction has a value less than 40%. Patients with an abnormal gallbladder ejection fraction should undergo cholecystectomy. This procedure has been shown to be effective in curing the symptoms in over 90% of patients.
-
Motility disorder of the sphincter of Oddi is called sphincter of Oddi dysfunction. This disorder is categorized as two distinct types—biliary sphincter of Oddi dysfunction and pancreatic sphincter of Oddi dysfunction.
-
Typically, patients with biliary sphincter of Oddi dysfunction present with biliary-type pain on average 4 to 5 years after having undergone cholecystectomy. Sphincter of Oddi manometry is essential in making a diagnosis of abnormal motility of the sphincter. On manometry, diagnosis of a sphincter of Oddi stenosis should lead to division of the sphincter. Sphincterotomy results in long-term relief of symptoms in more than 80% of patients.
-
Pancreatic sphincter of Oddi dysfunction clinically presents with recurrent episodes of pancreatitis of unknown cause. Having ruled out all of the common causes of pancreatitis, sphincter of Oddi manometry of the pancreatic duct sphincter should be performed. When manometric stenosis is diagnosed, these patients should undergo division of both the biliary and pancreatic duct sphincter. This treatment results in relief of symptoms in more than 80% of patients.
Article PDF
Similar content being viewed by others
Avoid common mistakes on your manuscript.
References and Recommended Reading
Rhodes M, Lennard TWJ, Farndon JR, Taylor RMR: Cholecystokinin (CCK) provocation test: long-term follow-up after cholecystectomy. Br J Surg 1988, 75:951–953.
Bar-Meir S: Frequency of papillary dysfunction among cholecystectomized patients. Hepatology 1984, 4:328–330.
Toouli J, Roberts-Thomson I, Dent J, Lee J: Manometric disorders in patients with suspected sphincter of Oddi dysfunction. Gastroenterology 1985, 88:1243–1250. In this study sphincter of Oddi dysfunction is defined and characterized via manometry.
Toouli J, Roberts-Thomson I, Dent J, Lee J: Sphincter of Oddi manometric disorders in patients with idiopathic recurrent pancreatitis. Br J Surg 1985, 72:859–863.
Nardi GL, Acosta JM: Papillitis as a cause of pancreatitis and abdominal pain: role of evocative test operative pancreatography and histologic evaluation. Ann Surg 1966, 164:611–621.
Bobba VR, Krishnamurthy GT, Kingston E, et al.: Gallbladder dynamics induced by a fatty meal in normal subjects and patients with gallstones: concise communication. J Nucl Med 1984, 25:21–24.
Yap L, McKenzie J, Wycherley A, Toouli J: Acalculous biliary pain: cholecystectomy alleviates symptoms in patients with abnormal cholescintigraphy. Gastroenterology 1991, 101:786–793. This is the first study to demonstrate the efficacy of the gallbladder ejection fraction in the treatment of gallbladder dyskinesia.
Hunt DR, Scott AJ: Changes in bile duct diameter after cholecystectomy: a 5-year perioperative study. Gastroenterology 1989, 97:1485–1488. In this study, it was demonstrated that a dilated bile duct is not a normal consequence of cholecystectomy but reflects an abnormality.
Corazziari E, Cicala M, Habib FI, et al.: Hepatoduodenal bile transit in cholecystectomized subjects. Relationship with sphincter of Oddi function and diagnostic value. Dig Dis Sci 1993, 39:1985–1993.
Wehrmann T, Lembeke B, Caspary W, Seifert H: Sphincter of Oddi dysfunction after successful gall stone lithotripsy. Dig Dis Sci 1999, 44:2244–2250.
Thune A, Scicchitano J, Roberts-Thomson I, Toouli J: Reproducibility of endoscopic sphincter of Oddi manometry. Dig Dis Sci 1991, 36:1401–1405.
Mendaczy L, Middelfurt HV, Matzen P, et al.: Quantitative hepatobiliary scintigraphy and endoscopic sphincter of Oddi manometry in patients with suspected sphincter of Oddi dysfunction: assessment of the flow pressure relationship in the biliary tract. Eur J Gastroenterol 2000, 12:777–786.
Geenen JE, Hogan WJ, Dodds WJ, et al.: The efficacy of endoscopic sphincterotomy in post-cholecystectomy patients with sphincter of Oddi dysfunction. N Engl J Med 1989, 320:82–87. This is the first study that demonstrated the efficacy of endoscopic sphincterotomy in treating sphincter of Oddi dysfunction.
Toouli J, Roberts-Thomson IC, Kellow J, et al.: Manometry based randomised trial of endoscopic sphincterotomy for sphincter of Oddi dysfunction. Gut 2000, 46:98–102. In this study, the efficacy of endosopic sphincterotomy in the treatment of manometric sphincter of Oddi stenosis is defined through a prospective randomized study.
Toouli J, Difrancesco V, Saccone G, et al.: Division of the sphincter of Oddi for treatment of dysfunction associated with recurrent pancreatitis. Br J Surg 1996, 83:1205–1210.
Toouli J, Craig A: Sphincter of Oddi function and dysfunction. Can J Gastroenterol 2000, 14:411–419.
Craig A, Toouli J: Slow release nifedipine for patients with sphincter of Oddi dyskinesia: results of a pilot study. Intern Med J 2002, 32:119–123.
Author information
Authors and Affiliations
Rights and permissions
About this article
Cite this article
Toouli, J. Biliary dyskinesia. Curr Treat Options Gastro 5, 285–291 (2002). https://doi.org/10.1007/s11938-002-0051-9
Issue Date:
DOI: https://doi.org/10.1007/s11938-002-0051-9